Healthcare Professionals

Staging of Pancreatic Cancer

The TNM staging of pancreatic cancer takes into account the location and size of the tumor (T), the involvement of lymph nodes (N) and distant metastasis (M). There are various systems of staging, like the UICC TNM classification, Japanese Pancreatic Society (JPS) classification, and American Joint Committee for Cancer (AJCC) system. Advances in knowledge and experience have lead to upgradation in the classification parameters of each of these systems. The T and N parameters are similar in most of the systems but differences are evident in the stage grouping (for e.g. UICC stage II is equivalent to JPS stage IV in many cases). However, its routine use is debatable especially in pancreatic head lesions since operative palliation is a good action. In case of a left sided tumors (more often locally advanced/ metastatic), staging laparoscopy might prevent unnecessary laprotomy.

AJCC Stage Grouping

Stage Grouping for Tumors of the Pancreas
Stage	Tumor	Regional Lymph Nodes	Distant Metastases
Stage 0	Tis	N0	M0
Stage IA	T1	N0	M0
Stage IB	T2	N0	M0
Stage IIA	T3	N0	M0
Stage IIB	T1 T2 T3	N1 N1 N1	M0 M0 M0
Stage III	T4	any N	M0
Stage IV	any T	any N	M1

Definition of Tumor (T)
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
Tis	In situ carcinoma
T1	Tumor limited to the pancreas, 2 cm or less in greatest dimension
T2	Tumor limited to the pancreas, more than 2 cm in greatest dimension
T3	Tumor extends directly into any of the following: duodenum, bile duct, peripancreatic tissues
T4	Tumor extends directly into any of the following: stomach, spleen, colon, adjacent large vessels

Definition of Regional Lymph Nodes (N)
NX	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Regional lymph node metastasis pN1a= metastasis in a single regional lymph node pN1b= metastasis in multiple regional lymph nodes

The TNM staging system for Pancreatic Cancer
Stage	TNM Classification	Clinical Classification	distribution at diagnosis (%)	Median Survival (months)	Five-year survival rate(%)
0	TIS, N0, M0	Resectable	15 - 20	13 - 18	15.2
IA	T1, N0, M0
IB	T2, N0, M0
IIA	T3, N0, M0
IIB	T1- 3, N1*, M0	Locally advanced	40	8 - 9	6.3
III	T4, any N, M0 Any T, any N
IV	M1	Metastatic	45	4 - 6	1.6

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